title: Selective transitional zone sampling approach versus random biopsy in cases with malignant liver masses: is there any superiority?
abstract: OBJECTIVE
  Currently, the diagnostic sensitivity of malignant liver mass biopsies is an important problem in the definitive diagnosis. In this study, we aimed to investigate the role of selective peripheral approach to lesion biopsies for diagnostic sensitivity of liver masses.
  
  
  METHODS
  Between June 2007 and March 2011, totally 88 patients (50 male, 38 female), referred to our Interventional Radiology Department for sonographically guided Tru-cut biopsies for liver lesions, were examined.All biopsies were performed by an experienced radiologist with an 18-gauge Tru-cut biopsy needle with a spring-loaded biopsy gun under sonographic guidance. We describe two locations (peripheral and central) for liver lesions, with the inner 2/3 part of the mass as central and the outer 1/3 part as peripheral. We obtained biopsy from both of these locations, and samples were transferred to the Pathology Department separately.
  
  
  RESULTS
  According to pathological and immunohistochemistry studies, there were 42 hepatocellular carcinomas and 46 metastases. All of the metastatic tumors were stained by cytokeratin (10 lung adenocarcinoma, 15 breast adenocarcinoma, 16 gastrointestinal tract, 4 prostate, and 1 malignant melanoma of these 46 metastases were reported as primary). According to histopathological results, diagnostic sensitivity was 97.7% in peripherally located biopsies and 86.3% in biopsies taken from the center of the masses (p=0.0063).
  
  
  CONCLUSIONS
  Selective peripheral biopsy approach in Tru-cut biopsies of liver lesions has better sensitivity rates for histopathologic diagnosis compared to the centrally located and random biopsies.
authors.affiliation: Şişli Etfal Training and Research Hospital, Department of Radiology, İstanbul, Turkey. caliskancan@gmail.com
authors.forename: Kosti Can
authors.initials: KC
authors.lastname: Çalişkan
authors.forename: Banu
authors.initials: B
authors.lastname: Özgüven
authors.forename: Mehmet Sait
authors.initials: MS
authors.lastname: Buğdaci
authors.forename: Emin
authors.initials: E
authors.lastname: Çakmakci
authors.forename: Umut Perçem
authors.initials: UP
authors.lastname: Orhan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ertürk
authors.forename: Zeki
authors.initials: Z
authors.lastname: Karpat
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Başak
authors.forename: Fatih
authors.initials: F
authors.lastname: Selçukbırıcık
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D001707:Biopsy, Needle / Q000379:methods* / Q000592:standards*; D001943:Breast Neoplasms / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000473:pathology*; D003402:Creatine Kinase / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000556:secondary; D006801:Humans; D007633:Keratins / Q000378:metabolism; D008103:Liver Cirrhosis / Q000378:metabolism / Q000473:pathology*; D008113:Liver Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000556:secondary*; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000556:secondary; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000473:pathology; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D007633:Keratins; D003402:Creatine Kinase